Employee health insurance second reimbursement of major medical conditions have

The second reimbursement of medical insurance requires the condition that the individual's out-of-pocket medical expenses exceed the starting line of the major medical insurance. The second reimbursement is actually the second reimbursement of the major medical insurance, that is, the insured person has a serious illness, incurred a huge amount of medical expenses, after the basic medical insurance reimbursement, the amount is still very high, more than the starting line, in order to alleviate the medical burden of the insured person, you can then report.

What does the reimbursement scope of the medical insurance generally include

1, the medical insurance drug catalog: the drug catalog of the medical insurance is generally divided into class A and class B. The medical insurance is not only for the medical insurance, but also for the medical insurance. The first one is the one that is included in the reimbursement, and then it is reimbursed according to the specified percentage, while the second one is the one that requires the individual to pay a certain percentage out of pocket, and then the rest is included in the reimbursement, and then it is reimbursed according to a certain percentage. The other drugs are not eligible for reimbursement, such as diet pills, infertility drugs, etc.

2. Diagnostic and treatment items are reimbursed in the clinical diagnostic and treatment categories, which are necessary, safe, effective, and affordable, and are subject to customized fees and charges by the pricing department. The rest of the items can not be reimbursed, such as: registration fees, cosmetic surgery, dental and other items can not be reimbursed;

3, medical-related services and facilities directory: generally provided by the designated medical institutions, the insured will generally need to receive diagnosis, treatment, care in the process of receiving the necessary services and facilities.

Legal Basis: Article 23 of the Social Insurance Law of the People's Republic of China

Employees shall participate in the basic medical insurance for employees, and shall pay the basic medical insurance premiums by the employer and the employees in accordance with the state regulations***.

Individual industrial and commercial households without employees, part-time employees who do not participate in the basic medical insurance for employees at their employing units, and other flexibly employed persons may participate in the basic medical insurance for employees, and individuals shall pay the basic medical insurance premiums in accordance with the State regulations.

Article 24

The State establishes and perfects a new type of rural cooperative medical care system.

Methods for administering the new type of rural cooperative medical care shall be prescribed by the State Council.